Preventive maintenance in student housing and malaria risk reduction among universities in Ghana: an ecological systems perspective

BackgroundSeveral studies have reported an association between malaria infection of the placenta and the risk of malaria in young children in the first year of life, but it is not known if this is causal, or influenced by malaria control measures during pregnancy. This paper compares the incidence of malaria in infants born to mothers who received either intermittent preventive treatment with sulfadoxine/pyrimethamine (IPTp-SP) or screening with a rapid diagnostic test and treatment with artemether–lumefantrine (ISTp-AL) during their pregnancy.MethodsFrom July 2011 to April 2013, 988 infants of women enrolled in a trial of IPTp-SP versus ISTp-AL in the Kassena-Nankana districts of northern Ghana were followed to determine the risk of clinical malaria during early life, and their risk of parasitaemia and anaemia at 6 and 12 months of age. In addition, the incidence of clinical malaria in infants whose mothers had malaria infection of the placenta was compared with that in infants born to women free of placental malaria.ResultsThe incidence of clinical malaria was 0.237 and 0.211 episodes per child year in infants whose mothers had received ISTp-AL or IPTp-SP, respectively. The adjusted incidence rate ratio and the adjusted rate difference were 0.94 (95 % CI 0.68, 1.33) and 0.029 (95 % CI −0.053, 0.110) cases per child year at risk respectively. The incidence of clinical malaria was similar in infants born to women with placental malaria (0.195 episodes per child year) and in infants of women without placental malaria (0.224 episodes per child year) (rate ratio = 0.86 [95 % CI 0.54, 1.37]).ConclusionInfants born to women managed with ISTp-AL during pregnancy were not at greatly increased risk of malaria compared with infants born to women who had received IPTp-SP. The incidence of malaria in infants was similar whether or not their mother had had placental malaria.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1094-z) contains supplementary material, which is available to authorized users.

Introduction: This research aimed to assess housing design consideration features and architects’ perceptions of their effectiveness in malaria prevention. Previous studies have highlighted various architectural design elements that can reduce mosquito entry into homes, thus contributing to malaria prevention. This study aims to build on these insights by evaluating specific design features and gathering professional opinions on their effectiveness.Methods: The methodological approach adopted was quantitative, with data collected using a structured questionnaire containing closed-ended questions and a checklist. The observation checklist was used to ascertain mosquito entry reduction features incorporated in 208 systematically selected houses in Garneton East, Kitwe, Zambia. Additionally, a structured questionnaire containing fourteen key design features identified from the literature was administered to 76 architects purposively sampled to establish their perceptions of the effectiveness of these design factors in malaria prevention. Data collected was analyzed using descriptive statistics and exploratory factor analysis.Results: The findings revealed that most houses needed to incorporate design features to reduce mosquito entry. The common features incorporated were ceilings (86.80%), screened air ventilation (59.80%), and window screens (54.40%). The use of window and door screens, as well as mosquito-repellent paint, were perceived as the most effective measures by the architects.Discussion: The results suggest a keen awareness among architects regarding the efficacy of certain design features in malaria prevention. Despite this awareness, the implementation of these features in actual housing designs needs to be improved. This indicates a need for greater effort and adaptation in building regulations to promote the use of mosquito entry reduction features. Enhancing housing designs with these features can significantly reduce malaria morbidity and mortality. Therefore, it is recommended that building regulations be updated to support and encourage the incorporation of mosquito entry reduction features in housing designs.

BackgroundRwanda reported significant reductions in malaria burden following scale up of control intervention from 2005 to 2010. This study sought to; measure malaria prevalence, describe spatial malaria clustering and investigate for malaria risk factors among health-centre-presumed malaria cases and their household members in Eastern Rwanda.MethodsA two-stage health centre and household-based survey was conducted in Ruhuha sector, Eastern Rwanda from April to October 2011. At the health centre, data, including malaria diagnosis and individual level malaria risk factors, was collected. At households of these Index cases, a follow-up survey, including malaria screening for all household members and collecting household level malaria risk factor data, was conducted.ResultsMalaria prevalence among health centre attendees was 22.8%. At the household level, 90 households (out of 520) had at least one malaria-infected member and the overall malaria prevalence for the 2634 household members screened was 5.1%. Among health centre attendees, the age group 5–15 years was significantly associated with an increased malaria risk and a reported ownership of ≥4 bednets was significantly associated with a reduced malaria risk. At the household level, age groups 5–15 and >15 years and being associated with a malaria positive index case were associated with an increased malaria risk, while an observed ownership of ≥4 bednets was associated with a malaria risk-protective effect. Significant spatial malaria clustering among household cases with clusters located close to water- based agro-ecosystems was observed.ConclusionsMalaria prevalence was significantly higher among health centre attendees and their household members in an area with significant household spatial malaria clustering. Circle surveillance involving passive case finding at health centres and proactive case detection in households can be a powerful tool for identifying household level malaria burden, risk factors and clustering.

To map at a fine spatial scale, the risk of malaria incidence for the important endemic region is Urabá-Bajo Cauca and Alto Sinú, NW Colombia, using a new modelling framework based on GIS and remotely sensed environmental data. The association between environmental and topographic variables obtained from remote sensors and the annual parasite incidence (API) for the years 2013-2015 was calculated using multiple regression analysis; subsequently, a model was constructed to estimate the API and to project it to the entire endemic region in order to design the risk map. The model was validated by relating the obtained API values with the presence of the three main Colombian malaria vectors, Anopheles darlingi, Anopheles albimanus and Anopheles nuneztovari. Temperature and Normalized Difference Water Index (NDWI) showed a significant correlation with the observed API. The risk map of malaria incidence showed that the zones at higher risk in the Urabá-Bajo Cauca and Alto Sinú region were located south-east of the region, while the northern area presented the lowest malaria risk. A method was generated to estimate the API for small urban centres, instead of the used reports at the municipality level. These results provide evidence of the utility of risk maps to identify environmentally vulnerable areas at a fine spatial resolution in the Urabá-Bajo Cauca and Alto Sinú region. This information contributes to the implementation of vector control interventions at the microgeographic scale at areas of high malaria risk.

Malaria is the leading cause of death globally, especially in sub-Saharan African countries claiming over 400,000 deaths globally each year, underscoring the critical need for continued efforts to combat this preventable and treatable disease. The objective of this study is to provide statistical guidance on the optimal preventive and control measures against malaria. Data have been collected from reliable sources, such as World Health Organization, UNICEF, Our World in Data, and STATcompiler. Data were categorized according to the factors and sub-factors related to deaths caused by malaria. These factors and sub-factors were determined based on root cause analysis and data sources. Using JMP 16 Pro software, both linear and multiple linear regression were conducted to analyze the data. The analyses aimed to establish a linear relationship between the dependent variable (malaria deaths in the overall population) and independent variables, such as life expectancy, malaria prevalence in children, net usage, indoor residual spraying usage, literate population, and population with inadequate sanitation in each selected sample country. The statistical analysis revealed that using insecticide treated nets (ITNs) by children and individuals significantly decreased the death count, as 1,000 individuals sleeping under ITNs could reduce the death count by eight. Based on the statistical analysis, this study suggests more rigorous research on the usage of ITNs.

Malaria prevention is important among HIV patients to mitigate its associated complications. This study explored the predictors of insecticide-treated net (ITN) usage among HIV patients attending an antiretroviral therapy (ART) clinic in Ebonyi state, Nigeria. It was a cross-sectional study that involved 297 patients who attended an ART clinic in Ebonyi State. An interviewer-administered questionnaire was used to collect relevant data which included perception of malaria prevention, ownership of ITN, condition of ITN, duration of use and ITN usage. The relationship between ITN usage and other variables was assessed using bivariate analysis and the predictors were determined using multivariate logistic regression. There were 64 (21.5%) males and 233(78.5%) females. Knowledge of the use of ITN (mean= 4.24 ±0.93) was rated better than knowledge of the use of mosquito repellent (mean = 3.79 ± 1.21) and knowledge of the use of protective clothes (mean= 3.86 ±1.26). 246 (83%) of the study population owned ITN. Only 48% (118) of those who had ITNs reported having optimal nets (nets without holes). 135 (45.5%) of the participants reported sleeping under the net every day in the past week. There was a significant relationship between ITN usage and knowledge of the use of ITN, ownership of ITN, duration of use and condition of nets. Predictors of usage of ITN were duration of use (AOR=0.386, 95%C.I for AOR=0.224-0.665) and condition of the nets (AOR=0.399, 95%C.I for AOR=0.226-0.706). Perception of malaria prevention was high among the study group. Ownership of ITN was high although many of the ITNs were not in good condition. Usage of ITN was largely determined by duration of use and good condition of nets. Yearly assessment of the condition of ITNs and replacement exercise of ITNs (2-3 years) at ART clinics to replace old and worn-out nets among HIV patients are recommended.

Source: Villamor E, Msamanga G, Saathoff E, et al. Effects of maternal vitamin supplements on malaria in children born to HIV-infected women. Am J Trop Med Hyg. 2007,76:1066–1071.Because the effects of maternal multivitamin supplementation on the risk of malaria in children are unknown,1,3,4 researchers from Boston, Mass; Munich, Germany; and Dar es Salaam, Tanzania, sought to learn the impact of providing multivitamins or vitamin A/β-carotene (VA/BC) supplements during pregnancy and lactation to HIV-infected women on their children’s risk of malaria in the first two years of life.A total of 1,078 HIV-infected pregnant women participated in this community-based, prospective, randomized, double-blind, placebo-controlled trial in Dar es Salaam. Antiretroviral therapy was unavailable at the time of the study. Women were randomized into one of four treatment arms: 1) multivitamins; 2) VA/ BC; 3) multivitamins and VA/BC; and 4) placebo. Multivitamins included B1, B2, B6, niacin, B12, C, E, and folic acid. The VA/BC supplements included 5,000 IU vitamin A plus 30 mg β-carotene. All women received daily folic acid and iron along with weekly chloroquine prophylaxis during pregnancy. Additionally, women in groups 2 and 3 received a supplemental dose of vitamin A at delivery. At six months of age and every six months thereafter, all children received an oral dose of vitamin A. Almost all women breastfed their infants. Blood films looking for Plasmodium parasitemia were obtained at three-month intervals and during acute febrile episodes. Malaria-related outcomes were defined as: 1) any parasitemia ( ≥1/μL); 2) high parasitemia (≥5,000/μL); 3) clinical malaria (parasitemia ≥5,000/μL with an axillary temperature >37.5°C); and 4) death from malaria.Most women were HIV-asymptomatic with a mean CD4 count of 416. Data were analyzed on 829 live-born, singleton children who had at least one assessment of malaria during their first two years of life. Of these children, 30% became HIV-infected during the first two years of life while 20% died. There were 405 cases of parasitemia, 109 cases of high parasitemia, and 28 cases of clinical malaria.Maternal supplementation with multivitamins alone resulted in a statistically significant reduction of 71% in the risk of clinical malaria (P=.02) whereas VA/BC alone was related to a nonstatistically significant reduction in clinical malaria by 63% (P=.06). Maternal vitamin supplements had no effect on parasitemia defined as ≥1/μL. Multivitamin supplementation resulted in a nonstatistically significant 30% reduction of high parasitemia. This reduction appeared to be larger when multivitamins were administered together with VA/BC (43% reduction, P=.04). The children’s HIV status did not significantly modify the effect of vitamins on the malaria outcomes considered. HIV transmission occurred more frequently among children whose mothers received VA/BC (33.5%) compared with those who did not receive VA/BC (25.6%; P=.01). The authors conclude that although maternal multivitamin supplements may be of benefit in preventing malaria in infants in East Africa, they cannot advocate daily supplementation with these supplements to HIV-infected lactating women as a strategy to prevent malaria in children.Dr. Dinerman has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.While this study suggests a modest protective effect for maternal vitamin supplementation on malaria in children, VA/BC may have increased the risk of mother-to-child transmission of HIV. HIV transmission occurred in 34% of children whose mothers received VA/BC, compared to a transmission rate of 26% in the absence of supplementation. Consequently, the authors conclude that daily supplementation with VA/BC in HIV-infected women to reduce the risk of childhood malaria cannot be recommended at this time. Rather, they hypothesize that direct supplementation of vitamin A to children older than six months of age might be a safer public health intervention (a hypothesis not investigated in this study).Prior research in the field of prophylactic supplementation showed mixed results. A study in Papua New Guinea demonstrated a protective effect of vitamin A.1 By comparison, animal studies showed that vitamins B2, B6, and E could worsen malaria.2 Another study demonstrated that iron, thiamine, riboflavin, and vitamin C had no effect on malaria.3 Additionally, a study in Tanzania showed that vitamins A, B, C, D, and E plus iron had no impact on malaria incidence.4 While vitamin supplementation is academically interesting, insecticide-treated nets (ITNs) and community education will continue to have the greatest impact on preventing malaria in children in Africa.

This paper examines the marijuana usage among university students in Ghana. A focused interview
\nwas done to solicit information from users of the drug. It paid attention to thematic areas that are
\nreplete in the existing literature concerning the use of marijuana and its ramifications on student users
\nof the drug. Attention is paid to the factors that drive the students to use the drug and its ramifications
\non their performance as students. Results and discussions that emanated from this severally qualitative
\nstudy with some quantitatives should serve as bases for university administrators and lecturers to see
\nthe need to enhance their efforts in training peer educators and counseling units in universities in
\nAfrica and Ghana in particular

BackgroundMosquito-borne diseases remain a significant public health problem in tropical regions. Housing improvements such as screening of doors and windows may be effective in reducing disease transmission, but the impact remains unclear.ObjectivesTo examine whether housing interventions were effective in reducing mosquito densities in homes and the impact on the incidence of mosquito-borne diseases.MethodsIn this systematic review and meta-analysis, we searched 16 online databases, including NIH PubMed, CINAHL Complete, LILACS, Ovid MEDLINE, and Cochrane Central Register of Controlled Trials for randomized trials published from database inception to June 30, 2020. The primary outcome was the incidence of any mosquito-borne diseases. Secondary outcomes encompassed entomological indicators of the disease transmission. I2 values were used to explore heterogeneity between studies. A random-effects meta-analysis was used to assess the primary and secondary outcomes, with sub-group analyses for type of interventions on home environment, study settings (rural, urban, or mixed), and overall house type (traditional or modern housing),ResultsThe literature search yielded 4,869 articles. After screening, 18 studies were included in the qualitative review, of which nine were included in the meta-analysis. The studies enrolled 7,200 households in Africa and South America, reporting on malaria or dengue only. The type of home environmental interventions included modification to ceilings and ribbons to close eaves, screening doors and windows with nets, insecticide-treated wall linings in homes, nettings over gables and eaves openings, mosquito trapping systems, metal-roofed houses with mosquito screening, gable windows and closed eaves, and prototype houses using southeast Asian designs. Pooled analysis depicted a lower risk of mosquito-borne diseases in the housing intervention group (OR = 0.68; 95% CI = 0.48 to 0.95; P = 0.03). Subgroup analysis depicted housing intervention reduced the risk of malaria in all settings (OR = 0.63; 95% CI = 0.39 to 1.01; P = 0.05). In urban environment, housing intervention was found to decrease the risk of both malaria and dengue infections (OR = 0.52; 95% CI = 0.27 to 0.99; P = 0.05).Meta-analysis of pooled odds ratio showed a significant benefit of improved housing in reducing indoor vector densities of both Aedes and Anopheles (OR = 0.35; 95% CI = 0.23 to 0.54; P<0.001).ConclusionsHousing intervention could reduce transmission of malaria and dengue among people living in the homes. Future research should evaluate the protective effect of specific house features and housing improvements associated with urban development.

Malaria continues to pose a serious public health challenge in Zamfara State, Nigeria, disproportionately affecting women and children due to socio-economic barriers. This study aimed to develop a Composite Gender-Sensitive Malaria Vulnerability Index (CGMVI) to identify areas of heightened malaria vulnerability and support informed targeted interventions. Malaria incidence and mortality data from the Malaria Atlas Project, and population data from WorldPop, were integrated with indicators of Insecticide-Treated Net (ITN) access and usage, maternal education, and household wealth. A Pentagonal Fuzzy Analytic Hierarchy Process was used to compute the CGMVI, while Getis-Ord Gi* hotspot analysis identified spatial patterns of vulnerability across Zamfara State. The CGMVI revealed a west-to-east gradient of malaria vulnerability across Zamfara State, with hotspots in Gummi (3.86) and Bukkuyum (3.62), characterized by low ITN usage (82-85%), high maternal education deficits (89-91%), and household poverty (85-90%). Moderate vulnerability was observed in central Local Government Areas (LGAs) such as Anka and Bungudu, while northern and eastern LGAs, including Shinkafi, Zurmi, and Tsafe, exhibited low vulnerability with higher ITN coverage (≈92%) and better socio-economic profiles. Hotspot analysis using Getis-Ord Gi* confirmed statistically significant clustering in western LGAs (z-scores 2.11-4.89 at 99% confidence), while coldspots in the north and east had z-scores from - 1.69 to - 3.39. These patterns reflect intersections of socio-economic barriers, ITN access, and maternal education, highlighting areas where women and children face elevated malaria risk. The study offers a spatial framework for understanding how epidemiological, socio-economic, and gender-related factors shape malaria vulnerability in Zamfara State. By identifying areas where women and children may face elevated risk, the findings can inform gender-sensitive ITN distribution, community malaria literacy initiatives, and socio-economic support strategies. The CGMVI provides a tool to guide evidence-informed planning and better integrate gender considerations into malaria control efforts in the state.

Malaria is well known public health menace in Nigeria with huge economic and social cost especially in institutions or university community, where it accounts for more outpatients’ visits than any other cause, yet the incidence of malaria is on the rise. This study examined the individual control strategy for malaria infestation among members of American University of Nigeria Community. The study utilized a descriptive survey approach. An internet base self-structured questionnaire randomly sent to both staff and students was used to elicit relevant information for the study. A total of 260 individuals responded to the questionnaire. Data from the clinic medical data base (Care plus) was used to ascertain the incidence of Malaria from January 2014 to June, 2016. Using line graph, percentage distribution table, mean and standard deviation for data analysis, findings from the study indicated an overall rise in the incidence of malaria. The mean and SD value of 56.7 ± 35.2 showed that individuals varied in their choice of preventive/control method for malaria infection. Most respondents 47.3% and 40 % would prevent malaria attacks by using insecticide spray and screening of doors and windows respectively. 23.1% of the respondents drain stagnant water (breeding site for mosquitoes) or use prophylactic malaria drug (22.7%). Less than 15% would use either of various other methods such as treated mosquito nets, clearing of surrounding bushes and grass, repellent creams, wear protective clothing or use mosquito coil/bat (5.8%). Based on the perceived factors which influence individual choice of adopting variety of methods to prevent malaria attack, 45% of the respondent reported lack of awareness as a major factor influencing malaria controls strategy and Location/Environment (36.9%), inefficient/incorrect use of preventive measures (30.4%). 20% considered cost, safety level of repellent, nets, insecticides and chemical/drug resistance as a factor with educational level perceived as been the least influential (16.9%). The study identified a lax in attitude and inefficient utilization of available resources. Therefore, it is imperative for every individual to be more proactive and conscientious in their approach towards the prevention and control of malaria infection. Heightened malaria awareness program as a way of public enlightenment synergized by enabling policies and strategic planning at specific periods of the year will go a long way in mitigating the incidence of malaria and the ripple effect it has on the nation.

House construction is rapidly modernizing across Africa but the potential benefits for human health are poorly understood. We hypothesised that improvements to housing would be associated with reductions in malaria, acute respiratory infection (ARI) and gastrointestinal illness in an area of low malaria endemicity in Uganda. Data were analysed from a cohort study of male and female child and adult residents (n = 531) of 80 randomly-selected households in Nagongera sub-county, followed for 24 months (October 4, 2017 to October 31, 2019). Houses were classified as modern (brick walls, metal roof and closed eaves) or traditional (all other homes). Light trap collections of mosquitoes were done every two weeks in all sleeping rooms. Every four weeks, we measured malaria infection (using microscopy and qPCR to detect malaria parasites), incidence of malaria, ARI and gastrointestinal illness. We collected 15,780 adult female Anopheles over 7,631 nights. We collected 13,277 blood samples of which 10.2% (1,347) were positive for malaria parasites. Over 958 person years we diagnosed 38 episodes of uncomplicated malaria (incidence 0.04 episodes per person-year at risk), 2,553 episodes of ARI (incidence 2.7 episodes per person-year) and 387 episodes of gastrointestinal illness (incidence 0.4 episodes per person-year). Modern houses were associated with a 53% lower human biting rate compared to traditional houses (adjusted incidence rate ratio [aIRR] 0.47, 95% confidence interval [CI] 0.32–0.67, p<0.001) and a 24% lower incidence of gastrointestinal illness (aIRR 0.76, 95% CI 0.59–0.98, p = 0.04) but no changes in malaria prevalence, malaria incidence nor ARI incidence. House improvements may reduce mosquito-biting rates and gastrointestinal illness among children and adults. For the health sector to leverage Africa’s housing modernization, research is urgently needed to identify the healthiest house designs and to assess their effectiveness across a range of epidemiological settings in sub-Saharan Africa.

House construction is rapidly modernizing across Africa but the potential benefits for human health are poorly understood. We hypothesised that improvements to housing would be associated with reductions in malaria, acute respiratory infection (ARI) and gastrointestinal illness in an area of low malaria endemicity in Uganda. Data were analysed from a cohort study of male and female child and adult residents (n = 531) of 80 randomly-selected households in Nagongera sub-county, followed for 24 months (October 4, 2017 to October 31, 2019). Houses were classified as modern (brick walls, metal roof and closed eaves) or traditional (all other homes). Light trap collections of mosquitoes were done every two weeks in all sleeping rooms. Every four weeks, we measured malaria infection (using microscopy and qPCR to detect malaria parasites), incidence of malaria, ARI and gastrointestinal illness. We collected 15,780 adult female Anopheles over 7,631 nights. We collected 13,277 blood samples of which 10.2% (1,347) were positive for malaria parasites. Over 958 person years we diagnosed 38 episodes of uncomplicated malaria (incidence 0.04 episodes per person-year at risk), 2,553 episodes of ARI (incidence 2.7 episodes per person-year) and 387 episodes of gastrointestinal illness (incidence 0.4 episodes per person-year). Modern houses were associated with a 53% lower human biting rate compared to traditional houses (adjusted incidence rate ratio [aIRR] 0.47, 95% confidence interval [CI] 0.32-0.67, p<0.001) and a 24% lower incidence of gastrointestinal illness (aIRR 0.76, 95% CI 0.59-0.98, p = 0.04) but no changes in malaria prevalence, malaria incidence nor ARI incidence. House improvements may reduce mosquito-biting rates and gastrointestinal illness among children and adults. For the health sector to leverage Africa's housing modernization, research is urgently needed to identify the healthiest house designs and to assess their effectiveness across a range of epidemiological settings in sub-Saharan Africa.

In this paper, we aim to evaluate the effectiveness of community-based interventions (CBIs) for the prevention and management of malaria. We conducted a systematic review and identified 42 studies for inclusion. Twenty-five of the included studies evaluated the impact of the community-based distribution of insecticide-treated nets (ITNs), indoor residual spraying (IRS), or impregnated bed sheets; 14 studies evaluated intermittent preventive therapy (IPT) delivered in community settings; two studies focused on community-based education for malaria prevention; and one study evaluated environmental management through drain cleaning.Our analysis suggests that, overall, the community-based delivery of interventions to prevent and control malaria resulted in a significant increase in ITNs ownership (RR: 2.16, 95% CI: 1.86, 2.52) and usage (RR: 1.77, 95% CI: 1.48, 2.11). However, usage of ITNs was limited to two-thirds of the population who owned them. Community-based strategies also led to a significant decrease in parasitemia (RR: 0.56, 95% CI: 0.42, 0.74), malaria prevalence (RR: 0.46, 95% CI: 0.29, 0.73), malaria incidence (RR: 0.70, 95% CI: 0.54, 0.90), and anemia prevalence (RR: 0.79, 95% CI: 0.64, 0.97). We found a non-significant impact on splenomegaly, birth outcomes (low birth weight, prematurity, stillbirth/miscarriage), anthropometric measures (stunting, wasting, and underweight), and mortality (all-cause and malaria-specific). The subgroup analysis suggested that community-based distribution of ITNs, impregnated bed sheets and IRS, and IPT are effective strategies. Qualitative synthesis suggests that high coverage could be achieved at a lower cost with the integration of CBIs with existing antenatal care and immunization campaigns. Community-based delivery of interventions to prevent and control malaria are effective strategies to improve coverage and access and reduce malaria burden, however, efforts should also be concerted to prevent over diagnosis and drug resistance.

BackgroundStudies of the association between malaria in pregnancy (MiP) and malaria during infancy have provided mixed results. A systematic review was conducted to evaluate available evidence on the impact of Plasmodium falciparum malaria infection during pregnancy, and intermittent preventive treatment of malaria during pregnancy (IPTp), on the risk of clinical malaria or parasitaemia during infancy.MethodsMEDLINE, EMBASE, Global Health, and Malaria in Pregnancy Library databases were searched from inception to 22 May 2018 for articles published in English that reported on associations between MiP and malaria risk in infancy. Search terms included malaria, Plasmodium falciparum, pregnancy, placenta, maternal, prenatal, foetal, newborn, infant, child or offspring or preschool. Randomized controlled trials and prospective cohort studies, which followed infants for at least 6 months, were included if any of the following outcomes were reported: incidence of clinical malaria, prevalence of parasitaemia, and time to first episode of parasitaemia or clinical malaria. Substantial heterogeneity between studies precluded meta-analysis. Thus, a narrative synthesis of included studies was conducted.ResultsThe search yielded 14 published studies, 10 prospective cohort studies and four randomized trials; all were conducted in sub-Saharan Africa. Infants born to mothers with parasitaemia during pregnancy were at higher risk of malaria in three of four studies that assessed this association. Placental malaria detected by microscopy or histology was associated with a higher risk of malaria during infancy in nine of 12 studies, but only one study adjusted for malaria transmission intensity. No statistically significant associations between the use of IPTp or different IPTp regimens and the risk of malaria during infancy were identified.ConclusionEvidence of an association between MiP and IPTp and risk of malaria in infancy is limited and of variable quality. Most studies did not adequately adjust for malaria transmission intensity shared by mothers and their infants. Further research is needed to confirm or exclude an association between MiP and malaria in infancy. Randomized trials evaluating highly effective interventions aimed at preventing MiP, such as IPTp with dihydroartemisinin–piperaquine, may help to establish a causal association between MiP and malaria in infancy.